HomeMy WebLinkAbout10030 (5) rt C1TY OF DIAMOND BAR EXPIRED
COMMUNITY DEVELOPMENT DEPARTMENT
�,.,� 21660 E.Copley Drive Suite 190 PRESS
(909)86a3195 Fax(909)861-3117 MAy O 9 2003
�'""' BUILDING PERMIT APPLICATION �IRMLY
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I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMP7 FROM TME CONTFiACTORS LI� GHfBAB/C81pOR
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w NRE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CANTqACTORS LI-
� CENSE LAW(CHAP7ER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � PooVSpa
FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS fOq THE ALLEGED EXEMP- ('
� TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PEN/LL7Y OF NOT MORE THAN FIVE HUNDRED DOLLAHS(f500).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, O COrtIffIBfC181
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR S/�LE(SEC.70N,BUSI- J
N NESS AND PROFESSIONS CODE:THE COMRACTORS LICENSE UW DOES NOT AFPLV TO AN OWNER OF �
PfiOPERTV WHO BUIlDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR
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w OFFEREDFORSALEIF,HOM/EVER7MEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
0 TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,AS OWNER OF 7HE PROPEHTY,AM E%CLUSIVELV CAN7RAC71NG N'I7H LICENSED CONTMCTORS
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W CENSE UW DOES NOTAPPLV TO AN OWNEH OF A PROPER7Y WH0 BUILDS OR IMPROVES 7HEREON.AND
� WFIOCANTfUCT5FOR5UCHGR0.1ECT5WITHACONTMCTOR�S)IICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
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DATE ONMER U
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�Q LICENSED CONTRACTORS DECLARATION W
CC I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � �
� Y(CAMMENCING WITH SECTION 7000)OF DIVISION�OF THE BUSINESS HJD PROFESSIONS CADE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT. m � .
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� WORKERS'COMPENSATION DECLARATION Q
� I HE BY AFFIRM UNDER VENAL7V OF PERIURV ONE OF 7HE FOLIAWING OECURATqNS: Z
� �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70 SELF-INSURE FOR NORKERS' _
Q COMPENSATION,AS PfiOVIDEO BV SECTION 770o OF TME LABOR CODE.FOR THE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � �
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION P p��
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS b /t /�
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY�NUMBER ARE: CONSTRUCTION �� "
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(} SH�LL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECAME SUBJEC7 TO7HE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE �
? SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR � _
CODE,I SHALL.FORTHWITI COMPLV WITH THOSE PROVISIONS. ISSUANCE
� SMIP
p DATE: APPLICANT:
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL.AND SHALL BE ENERGY P/C
� SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP 700NE HUNDRED 7HOUSAND ENERGY PERMIT
DOLURS(f700.000),IN ADDITION TO THE COS70F COMPENSATqN,DAMAGES AS PROVIDED FOR IN
� SECTION 370E Of THE UBOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE: �-�
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBYAFFIRM UN�Efi PENALTV OF PERIURV THAT 7HERE IS ACANS7RUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30Y7,CIV.C.).
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� LENDEH'S NAME
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H LENOERSAODRESS
� TOTAL FEES
� 1 CERTIFY THAT I HAVE READ 7HIS APPLICA7qN AND STATE THAT THE ABOVE INFORMATION IS CORRECT. �
w 1 AGREE TO COMPLV WITH ALL CI7Y MID COUNTV ORDINANCES AND STATE UWS REU7ING TO BUILDING
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CONSTRUCTION,ANO HEREBY AUTHORIZE REPRESENTA71VE5 OF THIS COUNTY TO ENTER UPON THE �
Z /�BOVE•MENTIONED PROVERTY FOR INSPECTION PURPOSES. COMMENTS �_
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WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—AppllcanYs Copy
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ELECTRIC GROUfVD UND R FLOOR DUCT •
GROUND PLUMBING ' UNDER FLOOR CUMDUIT -
SLAB GRADE FIREPLACE FOUPVDATIOfV
TEMP POlAIER FIREPLACE BOND BEAM �
VUATER SERVICE - MID HT. BOND BEAM
ROOF SHEATHtNG 8 FT. BOPVD BEAM
FRAMI�G/VENTILIATIO�1 FIiVAL BOND BEAM
ROOF COVER PRE-GRADIiVG - �
ROUGH HEATIfVG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING ' FIMISH GRADING �
SH01�/EN/TUB TEST POOL ELECTRIC •
EXT. LATH/SIDING POOL FENCING
1AIALL INSULATION POOL FINAL
CEILING INSUl�4TI0iV OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IfViPS.
GAS AIR TEST FINAL ZONING . �
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATIfVG HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FIWP,L PLUMBING ENEFiGY
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